Demand-withdraw interaction in family therapy for adolescent drug abuse
AuthorRynes, Kristina N.
Rohrbaugh, Michael J.
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractDemand-withdraw interaction is a pattern of communication in which one person demands change from another who withdraws. In the treatment domain, evidence of parallel demand-withdraw processes comes from a study of couple therapy for alcoholic men, where wife-demand/husband-withdraw interaction predicted poor response to a high-demand intervention (Shoham et al., 1998). The current study extends this parallelprocess idea to family therapy for substance-using adolescents by examining whether adolescents entrenched in parent-demand/adolescent-withdraw interaction are less likely to engage in treatment and more likely to use drugs post-treatment when counselors pressure them to change. Participants were 91 families who received ≥ 4 sessions of Brief Strategic Family Therapy (BSFT; Szapocznik et al., 2003) in a multi-site clinical trial on adolescent drug abuse and an additional non-engagement sample of 21 families who completed ≤ 2 sessions. Before randomization, families completed videotaped family interaction tasks from which trained observers coded parent-demand/adolescent-withdraw. Another team of raters coded therapists’ demands during an early and (for most cases) a later BSFT session, while a third team rated quality of BSFT. The main dependent variable was a composite index of adolescent substance use based on monthly self-reports and urine drug screens over 12 months. A matched-sample examination of sessions attended (≤ 2 vs. ≥ 4) revealed no effect of early-session therapist demand on engagement. However, multi-level models partially supported the main hypothesis: adolescents high in parent-demand/adolescent withdraw who received high-quality BSFT from relatively non-demanding therapists used fewer drugs during and after treatment than other adolescent participants. Furthermore, as therapist demand on high PD/AW adolescents increased, youth substance use also increased. Results suggest that attending to parallel demand-withdraw processes in parent/adolescent and therapist/adolescent dyads may be useful in family therapy for substance-using adolescents. Replicating ineffective parent behavior within the therapeutic system may undermine the prospect of decreased adolescent drug use outcomes.